Healthcare Provider Details

I. General information

NPI: 1992243075
Provider Name (Legal Business Name): KATHERINE SKILLESTAD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE AVANESYAN DDS

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 COLONY RD
DURHAM NC
27705-5501
US

IV. Provider business mailing address

2919 COLONY RD
DURHAM NC
27705-5501
US

V. Phone/Fax

Practice location:
  • Phone: 919-493-4911
  • Fax:
Mailing address:
  • Phone: 919-493-4911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number11337
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number11337
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number32657
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: